Rural healthcare in the U.S. is under strain, and recent federal policy choices are making the situation worse, according to a MedPage Today opinion piece by Terry Adirim, a physician and former military health system leader. The author points to widening rural-urban mortality gaps and a steady loss of local services, including obstetric units, as evidence that geography increasingly determines the care rural Americans can access.
The piece focuses on two federal actions. First, the 2025 budget reconciliation law is projected to cut federal Medicaid spending by $911 billion over a decade, with KFF estimating a $137 billion reduction in rural areas over the same period. Because Medicaid covers one in four rural adults and about half of rural births, the author argues these cuts will hit rural hospitals hard. Second, a proposed DHS fee of $103,265 on cap-subject H-1B petitions could raise the cost of hiring international physicians, who rural counties rely on at higher rates than urban counties.
The author acknowledges the $50 billion Rural Health Transformation Program as a positive step but says it is temporary and too small to offset the Medicaid reductions. The piece concludes that technology and telehealth cannot replace closed hospitals or absent specialists, and that rural healthcare needs stable financing before it can be transformed.